In line with the ESC mission, newly presented content is made available to all for a limited time (4 months for ESC Congress, 3 months for other events). ESC Professional Members, Association Members (Ivory & above) benefit from year-round access to all the resources from their respective Association, and to all content from previous years. Fellows of the ESC (FESC), and Professionals in training or under 40 years old, who subscribed to a Young Combined Membership package benefit from access to all ESC 365 content from all events, all editions, all year long. Find out more about ESC Memberships here.
One-hour algorithm for early rule-out and rule-in of acute myocardial infarction using sensitive cardiac troponin i
Authors : M Rubini Gimenez (Basel,CH), R Twerenbold (Basel,CH), T Reichlin (Boston,US), B Meller (Basel,CH), B Moehring (Basel,CH), P Haaf (Basel,CH), S Sou (Basel,CH), C Zellweger (Basel,CH), S Osswald (Basel,CH), C Mueller (Basel,CH)
M. Rubini Gimenez1
,
R. Twerenbold1
,
T. Reichlin2
,
B. Meller1
,
B. Moehring1
,
P. Haaf1
,
S. Sou1
,
C. Zellweger1
,
S. Osswald1
,
C. Mueller1
,
1University Hospital Basel, Department of Cardiology - Basel - Switzerland
,
2Brigham and Women's Hospital, Department of Medicine, Cardiovascular Division - Boston - United States of America
,
Purpose: Recent studies developed a 1h algorithm for rapid rule-out and rule-in of Acute Myocardial Infarction (AMI) based on high-sensitivity cardiac troponin T testing. We aimed to extend these findings and to assess whether a similar 1h algorithm can also be derived using a sensitive cardiac troponin I (s-cTnI) assay.
Methods: In a prospective international multicentre study we enrolled 912 consecutive patients presenting to the Emergency department (ED) with acute chest pain. S-cTnI (Beckman Coulter) was measured at presentation and after 1h in a blinded fashion. The final diagnosis was adjudicated by two independent cardiologists. An algorithm including the baseline s-cTnI values as well as absolute changes within the first hour was developed for early rule-in and rule-out of AMI.
Results: Among all patients 18% had a final diagnosis of AMI. The rule-out criteria of our algorithm were defined as baseline s-cTnI level lower than 0.009ug/l and an absolute change within the first hour of less than 0.005ug/l, and the rule-in criteria were defined as baseline s-cTnI level of 0.070ug/l or higher or an absolute change within the first hour of 0.015ug/l or higher. Applying the algorithm 50% patients could be classified as rule-out, 20% patients as rule-in, and 30% as in an observational zone. Overall, this resulted in a sensitivity and negative predictive value (NPV) of 97.8% and 99.2% respectively for rule-out, and specificity and positive predictive value (PPV) of 95.1% and 75.0%, respectively for rule-in, and an AMI prevalence of 9% in the observational zone group.
Conclusion: Using the novel algorithm based on s-cTnI baseline values and absolute changes within 1 hour allows a safe rule-out and an accurate rule-in within 1h in 70% of unselected patients with acute chest pain. The NPV is only slightly lower as compared to the use of hs-cTnT.
